QUALITY MANAGEMENT SPECIALIST

California  ‐ Onsite
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Keywords

Description

The Quality Management Specialist will utilize major components of population health and diabetes disease management, ensuring healthcare interventions for individuals and populations of members with prevalent and/or chronic diabetes in order to achieve disease management compliance, improved overall quality of life, and reduced healthcare costs. This position is also expected to perform clinical nursing care in the execution of diabetes disease management services and is responsible for coordinating health care interventions and communications for members with chronic diabetes.

The duties include working with members to provide telephone based care in a way that produces behavior changes. Disease management responsibilities also include calling members for quarterly monitoring, updating the disease management application with assessment results, communicating with the members' Providers as needed, referring members to contracted Community Based Organizations and to the company's Health Education Department for diabetes education classes as needed, supporting the diabetes telephone resource line, and working with the disease management team to update and maintain quality standards. Additionally, this position supports the physician or practitioner/member relationship and plan of care; emphasizes prevention of exacerbations and complications utilizing evidence-based practice guidelines and member empowerment strategies; evaluates clinical, humanistic, and economic outcomes on an on-going basis with the goal of improving overall health; and proactively coordinates with the Case Manager and Utilization Manager as needed.

The Quality Management Specialist will manage information that varies in complexity and derives from a range of internal and/or external sources; will assist in the identification and stratification of individual members and populations of members across the spectrum of care at risk for chronic diabetes and co-morbid conditions, and will evaluate the incidence of such conditions from a variety of established data bases and referrals. This person must be able to use relevant IT software as appropriate to perform job-related tasks; must possess excellent document design and/excel spreadsheet skills, which are generally used for reporting and retrieval of member information for member educational interventions. Will provide documentation of ongoing compliance with requirements.

SKILLS:

EDUCATION:

  • Required: BSN
  • Preferred: Master's in Business, Nursing or other Health related field. CDE (Certified Diabetes Educator)
LICENSES/CERTIFICATIONS
  • Required: Current unrestricted California RN license; valid California driver's license.
EXPERIENCE
  • Required: 2-4 years experience in management of patient populations with prevalent and chronic diseases, preferably with Medicaid population; facilitating quality/process improvement and/or updating policies and procedures with latest regulatory and accreditation standards; excellent oral and written communication skills; critical thinking skills and the ability to efficiently and effectively assimilate information and communicate that information clearly and promptly to internal and external stakeholders at all levels; identifies, develops and executes appropriate disease management activities and interventions; proficiency with MS Office (Word, Excel, Outlook, PowerPoint.)
  • Preferred: Motivational Interviewing Training.
FOREIGN LANGUAGE
  • Required Spanish
Start date
n.a
From
Synectics
Published at
27.12.2014
Project ID:
827889
Contract type
Freelance
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